Trauma center level impacts survival for cirrhotic trauma patients

Marko Bukur, Seth I. Felder, Matthew B. Singer, Eric J. Ley, Darren Malinoski, Daniel R. Margulies, Ali Salim

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied. METHODS: The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity. Patients who were dead on arrival, died in the emergency department, or had missing trauma center information were excluded. Our primary outcome measure was overall mortality stratified by admission trauma center level. Logistic regression analysis was used to derive adjusted mortality results. RESULTS: A total of 3,395 patients met inclusion criteria (0.16% of all National Trauma Databank patients). Patients admitted to a Level I center were more likely to be younger and minorities, experience penetrating injuries, and require immediate operative intervention despite similar Injury Severity Scores (ISS). Overall mortality was lower at Level I centers compared with other centers (10.3% vs. 14.0%, p = 0.001). After logistic regression, Level I centers were associated with significantly lower mortality compared with non-Level I centers (adjusted odds ratio, 0.70; 95% confidence interval, 0.53-0.89; p = 0.004). CONCLUSION: The mortality for cirrhotic patients admitted to a Level I trauma center was significantly less compared with those admitted to non-Level I centers. The etiology of this improved outcome needs to be identified and transmitted to non-Level I centers. LEVEL OF EVIDENCE: Epidemiologic study, level III.

Original languageEnglish (US)
Pages (from-to)1133-1137
Number of pages5
JournalJournal of Trauma and Acute Care Surgery
Volume74
Issue number4
DOIs
StatePublished - Apr 2013
Externally publishedYes

Fingerprint

Trauma Centers
Survival
Wounds and Injuries
Mortality
Fibrosis
Logistic Models
Databases
Injury Severity Score
Hospital Emergency Service
Comorbidity
Epidemiologic Studies
Odds Ratio
Regression Analysis
Outcome Assessment (Health Care)
Confidence Intervals
Morbidity

Keywords

  • Cirrhosis
  • critical care
  • outcomes
  • trauma center

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Surgery

Cite this

Bukur, M., Felder, S. I., Singer, M. B., Ley, E. J., Malinoski, D., Margulies, D. R., & Salim, A. (2013). Trauma center level impacts survival for cirrhotic trauma patients. Journal of Trauma and Acute Care Surgery, 74(4), 1133-1137. https://doi.org/10.1097/TA.0b013e3182858a59

Trauma center level impacts survival for cirrhotic trauma patients. / Bukur, Marko; Felder, Seth I.; Singer, Matthew B.; Ley, Eric J.; Malinoski, Darren; Margulies, Daniel R.; Salim, Ali.

In: Journal of Trauma and Acute Care Surgery, Vol. 74, No. 4, 04.2013, p. 1133-1137.

Research output: Contribution to journalArticle

Bukur, M, Felder, SI, Singer, MB, Ley, EJ, Malinoski, D, Margulies, DR & Salim, A 2013, 'Trauma center level impacts survival for cirrhotic trauma patients', Journal of Trauma and Acute Care Surgery, vol. 74, no. 4, pp. 1133-1137. https://doi.org/10.1097/TA.0b013e3182858a59
Bukur, Marko ; Felder, Seth I. ; Singer, Matthew B. ; Ley, Eric J. ; Malinoski, Darren ; Margulies, Daniel R. ; Salim, Ali. / Trauma center level impacts survival for cirrhotic trauma patients. In: Journal of Trauma and Acute Care Surgery. 2013 ; Vol. 74, No. 4. pp. 1133-1137.
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N2 - BACKGROUND: Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied. METHODS: The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity. Patients who were dead on arrival, died in the emergency department, or had missing trauma center information were excluded. Our primary outcome measure was overall mortality stratified by admission trauma center level. Logistic regression analysis was used to derive adjusted mortality results. RESULTS: A total of 3,395 patients met inclusion criteria (0.16% of all National Trauma Databank patients). Patients admitted to a Level I center were more likely to be younger and minorities, experience penetrating injuries, and require immediate operative intervention despite similar Injury Severity Scores (ISS). Overall mortality was lower at Level I centers compared with other centers (10.3% vs. 14.0%, p = 0.001). After logistic regression, Level I centers were associated with significantly lower mortality compared with non-Level I centers (adjusted odds ratio, 0.70; 95% confidence interval, 0.53-0.89; p = 0.004). CONCLUSION: The mortality for cirrhotic patients admitted to a Level I trauma center was significantly less compared with those admitted to non-Level I centers. The etiology of this improved outcome needs to be identified and transmitted to non-Level I centers. LEVEL OF EVIDENCE: Epidemiologic study, level III.

AB - BACKGROUND: Cirrhosis is known to be a significant risk factor for morbidity and mortality following trauma such that its presence is a requirement for trauma center transfer. The impact of trauma center level on post-injury survival in cirrhotic patients has not been well studied. METHODS: The National Trauma Databank (version 7) was used to identify patients admitted with cirrhosis as a preexisting comorbidity. Patients who were dead on arrival, died in the emergency department, or had missing trauma center information were excluded. Our primary outcome measure was overall mortality stratified by admission trauma center level. Logistic regression analysis was used to derive adjusted mortality results. RESULTS: A total of 3,395 patients met inclusion criteria (0.16% of all National Trauma Databank patients). Patients admitted to a Level I center were more likely to be younger and minorities, experience penetrating injuries, and require immediate operative intervention despite similar Injury Severity Scores (ISS). Overall mortality was lower at Level I centers compared with other centers (10.3% vs. 14.0%, p = 0.001). After logistic regression, Level I centers were associated with significantly lower mortality compared with non-Level I centers (adjusted odds ratio, 0.70; 95% confidence interval, 0.53-0.89; p = 0.004). CONCLUSION: The mortality for cirrhotic patients admitted to a Level I trauma center was significantly less compared with those admitted to non-Level I centers. The etiology of this improved outcome needs to be identified and transmitted to non-Level I centers. LEVEL OF EVIDENCE: Epidemiologic study, level III.

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